Healthcare Sustainability Lessons – From One Simple Visit

Funny thing happened last week, when I received a call from an automated robot scheduler. The message informed me that needed to schedule a physical exam – or lose the ability to continue care with my primary care provider.

Seems harsh – but actually it wasn’t completely unexpected. After all, this was just routine protocol in this highly progressive physician’s office practice in my hometown. They pride themselves on the most up-to-date medical care and technologies.

With that, the robot scheduler proceeded to provide me directions and in turn, I followed them. Voila – appointment made, and I soon received my blood slips to confirm that office visit.

WHERE’S RITA?

Hmmm…“where was Rita”?

The slightly overweight, curly haired grandmother of 11, who worked in their front office for years. The woman who bugged me about buying her granddaughter’s Girl Scout cookies? Rita always fit me in when I was sick at the time I needed, to avoid missing too much work. Because of these deeds, she ultimately created my loyalty to the practice.

On the day of the visit, a clipboard and a pleasant woman (still not Rita) offered to take my insurance card and a copy of my license. It seemed like a visit to the bank, as I we interacted through the glass partition. I’m surprised I didn’t have to pick up a telephone on my side of the wall.

I then proceeded to answer a five-page paper questionnaire. Umm…okay. Lucky for me (and them), all the boxes turned out to be marked “no”.

The good news…I was without issues, being a documented non-alcoholic, non-smoker and non-illicit drug user in no apparent distress. That is, other than having to fill out their form.

That done, I sat uneventfully in the waiting room, the usual 30 minutes quickly passing while reading expired magazines from a year ago. The medical assistant then called my name out. All right, let’s get this done.

She escorted me down a corridor full of public service announcement posters. Dead silence loomed and not much in the way of relationship bonding. A quiet stroll where I had some time to notice posters, lined up on the wall.

In any event, we came to the end of the corridor where the first next thing needed was to record my weight, the usual dreaded scale routine for most. The medical assistant asked if I would agree to get my weight checked and I said “of course, no issues here, scales don’t scare me only needles.

Truth was, being weighed was a requirement or my visit – that is, from the insurance side. Sometimes I wonder WHO they real customer is here. I joked with the woman about getting weighed, and there wasn’t even a chuckle. Only her noting all the times that patients who found this part of the visit to be painful – and would even refuse to be weighed.

I stepped up, and the first thing on my mind was the Ben & Jerry’s from the night before. I mean, it really was the ENTIRE pint – and this moment brought it back to my mind. Never the less, I came off with a great BMI of 19. I also noted the scale was top notch high-grade technology.

Coming in the exam room, I was greeted by more depressing posters: smokers dying of lung cancer, people being battered, overweight people needing hypnosis and of course the dreaded eye chart, which anyone with minimal vision probably could pass the chart, given I was only 5 feet away from it.

Despite the ‘posters of gloom’, I noticed all the equipment. Electronics such as digital blood pressure cuffs and the top of the line EHR staring me in the face. The assistant took my blood pressure, stuck the thermometer in my ear, checked my reflexes; and then took the clipboard, starting to input the 5-page questionnaire with my answers.

I asked her if all of the vitals automatically populated into the EHR and she said, “no we have to manually enter it”. Okay…someone may need to have a refresher on interconnectivity and visit efficiency. For the most part, she entered the data from the various sources with all answers reflective of a person caring for their health.

“Labs all normal, perfect cholesterol, nothing wrong with you. You take no medications, you aren’t depressed, you don’t have any aches or complaints and you eat healthy and exercise daily,” she said.

Then she asked what I do for exercise.

“Well, I try to do a daily run in the morning to give my dog exercise, depending on the weather around the block near my house, not fast just at pace and then I walk my adopted rescue dog daily in the evening because he needs to exercise. It’s simple, free and I have a companion who never fails me and forces me to exercise.”

It reminded me of a recent article I read from Gretchen Reynolds of the New York Times, discussing dog walkers and the ‘Lassie’ effect. Just put activities in motion you HAVE to do, and the exercise essentially comes along for the ride. Out of sight…out of mind.

She said, “That’s it?”

I snapped back to the present conversation adding, “That’s it”.

She frowned because I probably didn’t fit into her pattern of patient profiling or else she thought I was lying, couldn’t tell and didn’t want to ask. Then, it hit me – an epiphany.

I realized that I don’t fit in the norm of healthcare services today or at least they don’t fit my needs as a healthy person not needing anything except prevention and reinforcement to keep doing a great job. Yet, I am paying and professionally servicing those inneed of healthcare. Essentially, I am paying the same premiums probably as someone who utilizes far more services than I ever will. I also realized that the healthcare gadgets just weren’t what I needed and felt uncomfortable using them, but pressured to try them because everyone was doing it.

I also came to realize that in order to be and live healthy, you need to practice routines that fit into your life and lifestyle not be pigeon holed into the norm of how others practice their health care. Health care needs to service and individualize its offering and solutions based on state of health – healthy or otherwise in order to be sustainable.

For example, I love dogs. So, I adopted my rescue dog who turned into the best motivator and exercise buddy ever. Faithfully motivating me (or should I say reminding me) that unless I provide enough stimulation and exercise for him, he will tear up carpets, shoes and any belonging in the house, not to mention the bathroom issue, which in turn creates more work for me.

I think they call this loss aversion.

I came to realize that the best exercise anyone could have, is routine effortless exercise that fits into your lifestyle and something you don’t notice and enjoy. That is a major way to change the trajectory of health in the United States. Let health become part of our lives and routines – whatever that may be.

As for all of the technology motivators gifted and offered to me, I actually did try them for a bit, but shut them off or conveniently forgot them when I knew I was going out for an event or was just plain not interested in being motivated. In essence, I created my own work around using intrusive technologies that just didn’t work for me – as they do for others.

Because they were not true internal personal motivators, just reminders to make me feel guilty I should be doing something I wasn’t or had planned to do that day.

The medical assistant piped back in, “Well, you are the first patient in two weeks who has a normal BMI. It seems that everybody wants me to review their monitoring devices to attest to their exercise efforts to ensure their healthy lifestyle habits.”

My time was almost up.

“So, why are you here today?” she asked me.

“Well, you actually called me – I didn’t call specifically needing an appointment for anything. I needed to be seen TO STAY in your practice”.

She then replied, “Yes that is our policy”. The assistant left the room and in short order the nurse practitioner entered, reviewed all of the data inputted by the assistant, shook my hand and told me to have a great day and asked if I had any further questions.

I had just one question.

“Do you have any healthy lifestyle things, I can and should be doing that I am not right now?”

She replied, “We generally don’t see healthy patients much anymore, there is always something wrong with someone at the end of the visit, you are unusual at best”.

I replied, “So, do I get any free coupons for healthy living food restaurants or anything like free exercise socks or something, like they do at the dentist’s office when I get my teeth cleaned? They generally give me a new toothbrush there and a tube of toothpaste, which I use when I travel.”

She said, “unfortunately no – but it must be nice to know you are fit and healthy. That should make you feel great”.

I smirked then added, “It would be great if you had a few happy posters on the wall encouraging others to keep up the great work besides all the doom and gloom on the walls”.

She said, “These are reminders for patients to stop what they are doing that is adversely affecting their health – but you can add your thoughts to the suggestion box. Is there anything else I can help you with?”

I replied, “I guess not unless you can help me with my $4,962.00 dollar deductible and my $75.00 copay for today’s visit.”

That visit reinforced some major problems that still exist – even in the most technologically advanced offices.

First, patients need to be interacted with – based on an individual and personalized manner. Second, not all patients gain encouragement for taking action, based on negative messages. Finally, that healthy people continue, with our current risk-sharing payment models, to be financially penalized for doing the right things and carrying great health.

We wonder why healthcare hasn’t improved. It’s because the model and the practices (within the practices) need transformation….and fast!

This article was WRITTEN BY EXPERT: Helen Figge, PharmD, MBA, FHIMSS. She is the senior vice president of global strategic development for Waltham, Mass.-based LumiraDx USA. She was also selected as a top 25 Female Leader in Healthcare IT.

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